Predictors of hospitalization due to febrile neutropenia in cancer patients receiving chemotherapy

Abstract

Background Febrile neutropenia (FN) is a serious and potentially life‐threatening complication of chemotherapy, frequently leading to hospitalization, treatment delays, and increased healthcare utilization. Identifying clinical factors associated with FN‐related hospital admission is essential for improving risk stratification and supportive care strategies. Methods This observational study evaluated cancer patients 2207 receiving chemotherapy who developed FN. Clinical, laboratory, and treatment‐related variables—including body mass index (BMI), hemoglobin level, absolute neutrophil count, chemotherapy cycle number, Eastern Cooperative Oncology Group (ECOG) performance status, and granulocyte colony‐stimulating factor (G‐CSF) prophylaxis—were analyzed. Multivariable logistic regression was performed to determine independent predictors of FN‐related hospitalization. Results FN‐related hospitalization was associated not only with neutrophil count but also with multiple clinical parameters. Lower hemoglobin levels, poorer ECOG performance status, lower chemotherapy cycle number, and BMI were identified as independent predictors. The inverse association between chemotherapy cycle number and hospitalization risk (OR = 0.96) supports the established pattern of FN occurring more frequently during early treatment cycles. Patients requiring hospitalization had a lower mean number of chemotherapy cycles, consistent with early‐cycle vulnerability. Although the model demonstrated statistical significance, its explanatory power was modest (Nagelkerke R 2 = 0.053), suggesting the contribution of additional unmeasured factors. Conclusion FN‐related hospitalization in patients receiving chemotherapy is influenced by multidimensional clinical factors beyond neutrophil count alone. Performance status, hematologic reserve, BMI, and treatment timing play important roles in risk determination. Early identification of high‐risk patients and implementation of individualized monitoring and prophylactic strategies may improve patient safety and optimize healthcare resource utilization. Prospective, multicenter studies are warranted to develop and validate risk‐based care models aimed at reducing FN‐related hospitalizations.